Zhang FM, Ning LG, Wang JJ, Zhu HT, Feng MB, Chen HT. Invasive inflammatory fibrotic polyp of the duodenum: A case report. World J Gastrointest Surg 2025; 17(8): 107558 [PMID: 40949391 DOI: 10.4240/wjgs.v17.i8.107558]
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08634476
Submitted on:
August 30, 2025, 10:51
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Reader Comments:
Dear Author,
We read with great interest the case report by Zhang et al. describing a rare invasive inflammatory fibrotic polyp (IFP) of the duodenum with subserosal involvement. This first documented case of duodenal IFP extending beyond the muscularis propria (Figure 5A) provides valuable insights into the potential invasiveness of this entity. However, two key limitations warrant attention to enhance the clinical applicability of this finding:
The preoperative evaluation revealed limitations: Biopsy limitations: Initial endoscopic biopsies yielded only necrotic tissue, failing to sample viable tumor areas (Figure 1). EUS-FNA not attempted: Despite EUS identifying muscularis propria involvement (Figure 2), fine-needle aspiration (FNA) was not performed to obtain diagnostic material. This led to misdiagnosis as a stromal tumor and unnecessary radical surgery (distal gastrectomy + lymphadenectomy). Current guidelines recommend EUS-FNA for submucosal duodenal masses to avoid overtreatment[1]. As shown in Figure 2B, the lesion size (37.1 mm × 24.5 mm) was amenable to FNA, which could have provided adequate tissue for CD34/SMA immunohistochemistry and potentially prevented surgery.
In conclusion, this case report fills the gap in the understanding of invasive duodenal IFP, but the above aspect need further improvement to better reveal the biological nature of the lesion and guide clinical practice. We look forward to seeing more in-depth studies on this rare disease in the future.
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